Overdose - What to do (and what not to do) in the event of an overdose

[Junkhead23]

Now first things first a heroin overdose can occur from injecting, snorting AND SMOKING! However it is highly unlikely if smoked as SWIY are highly likely to pass out before overdosing. Therefore the risk is greater with snorting and much greater from injecting. Most times when users overdose on heroin it is due to taking a break from using (being in prison or on holiday for example) and not reducing the amount used. Also occasionally an exceptionally strong batch of heroin can be on the streets which users are not used to which leads to overdose.

Symptoms of a Heroin overdose include but are not limited to:

• muscle spasticity
• slow and labored breathing
• shallow breathing
• stopped breathing (sometimes fatal within 2-6 minutes)
• pinpoint pupils
• dry mouth
• cold and clammy skin
• tongue discoloration
• bluish colored fingernails and lips
• spasms of the stomach and/or intestinal tract
• constipation
• weak pulse
• low blood pressure
• drowsiness
• disorientation
• coma
• delirium

DO's

If someone that you are with overdoses:

• Try to pinch them on the ear or your nail into the bed of theirs and also try to rub their sternum (breastplate). If they react then they are still alert if they do not however:

• PHONE an ambulance. Say you have an unconcious person and they will come straight away. Do not say drug overdose as this may bring police. Tell them what they have taken when they arrive.
  
• Clean up SWIY shit (needles and stuff)
  
• If nalaxone is available use it but beware when the awake they will be in violent withdrawals and will mos likely need hospital treatment or some benzos. Beware that they may come around and 20 minutes later the narcan has wore off they can collapse again.
• Put them into the recovery position and check their airways to make sure they have no swallowed their tongue or have been sick and this is blocking their airway.
  
• Check their pulse and see if they are breathing. If they have stopped breathing give them mouth to mouth (if you know how) or if their pulse has stopped try to restart their heart by giving CPR.
• If you are worried about the cops take them outside but stay with them. (in the UK this is not necessary as the police will not come in most circumstances) Stay with them if you do this until the ambulance arrives and notify the crew what they have taken.
  

DON'Ts

• Do not inject them with a stimulant as this will only make matters worse it will not liven them up.
• Do not inject them with salt or saline solution as this is also ineffective.
• Also injecting milk is also a complete waste of time.
• Leave them alone to get on with it or dump the body (Imagine it was SWIY)
• Not tell the paramedics what they have taken as this could waste vital time. The paramedics will not grass SWIY up.
• Kick them or do anything else to hurt them physically. Pinching the ears is just as good to see if they are alert
• Dump them in a cold bath. This can lead to shock

Remember an overdose doesn't have to be a death sentence if SWIY have the right person around

JH

Reputation Comments on this post:

	important things to know if one has to play ;)
	Wonderfull post, much needed information. keep up the good work
	Very good post, sir.
	Great post with solid info...except apnea(no breathing is fatal in 2-8 minutes, not hours).
	Great contribution. Important for all opiate users! Thanks. :)
	for reals. CPR is important for EVERYONE to know.

[Junkhead23]

Thought SWIM would bump this for the numerous newbies

[kaloochi]

What's 'bump'?

[Junkhead23]

you know like bump it up so others can see it

[xxdan123xx]

Good post man. Somthing everyswimer who uses should read

[HorseBucket]

Swims friends say if someones ODing you put them in a cold bath.

Reputation Comments on this post:

Pay attention to the info listed in the thread

[honourableone]

Originally Posted by HorseBucket

Swims friends say if someones ODing you put them in a cold bath.

If you read the post, this is mentioned in the "DON'TS" section with an explanation as to why.


One thing I have been curious about regarding Naxalone: if it is only available in tablet form can it still be used to treat overdose? Even when crushed and mixed with water there would be the issue of making breathing more difficult. Plus I have no idea how much longer it would take to work.

[Spucky]

Many Times the Rescue lost a lot of Time because they can`t found the Victim!
So it is very Important to make it easy to reach the Person,
send someone to the Entrance, Crossing, etc.!
Also if this House is a Squad or Crackhouse take care the Light.

Mouth to Mouth is in a case of a OD not the best advice,
Mouth to Nose look like more sucessful, because in the Case of a fatal OD
the muscle of the Tounge will be a drawback.
You have to control that the air reach the Pulmo (Lung)

Regards

[pinksox]

If one doesn't have Narcan and the patient is unconscious, call the medics for an "unresponsive sick person with trouble breathing." Don't tell the 911 operator its an OD. But make sure to tell the medics when they get there. Just motion to one of them to step aside in a non-threatening manner..or better yet...meet them outside as they arrive and are grabbing their bags and tell them there(away from the cops should they happen to show up anyways).

Most medics aren't there to rat you out. And medical disclosures are privacy protected under HIPAA and, by law, can not be legally disclosed to any person not directly involved in the patients care(this would be the cops).

If the patient is still responsive and someone has Narcan and you know they're not allergic, one might try giving some--remember you're still sharing a controlled substance without a license--and Narcan's halflife is no where close to that of opiates...so it WILL wear off most likely long before the person is out of OD-range. It's not at all uncommon, and is in fact the norm, to have to redose heroin OD patients every 20 minutes or so for several hours after an OD.

The standard dose of IV Narcan is 0.4mg IV push. But SWIM will often push half, provide adequate respiratory support and then give the other half, if needed in 5-7 minutes or so. A total of 2.0mg may be given...this will put many users into acute withdrawal...but even that amount may not be enough to bring back respiratory status in an intentional or very severe OD.

Narcan IV formulation can also be given IM(longer onset) or into the lungs via an ET tube.

SWIM would LOVE to see Narcan education programs for addicts in needle exchange programs and even maintainence clinics. All first responders should also be trained in IM administration of Narcan as well. It's pretty much a "no harm, no foul" kinda drug.

Reputation Comments on this post:

	useful info, thanks
	Very helpful advice.
	A good suggestion for a 911 OD call.

[trannyboy]

Really good information. Pinksox info is spot on. The reason for only pushing half the dose is depending on the severity of the overdose you can partially reverse the overdose without pushing the patient into full acute withdrawl which has it's own serious consequenses. Also use your knuckles to rub the sternum of an unresponsive patient, if you know their name use it a lot when trying to get a response as it will decrease the likelyhood of the patient becoming combative. Under no circumstances place an overdosing or unconcsious patient in a cold or hot shower or bath; shock, drowning, hypo/ hyperthermia and altered blood pressure can result sending the patient into cardic arrest. If you have narcan use it but do not administer any other medications unless you are a medical profession and know exactly how to use them safely. Lots of really good advice here. I would love to see first aid/ responder with narcan training provided by every maintaince/ rehab/ needle exchange/ HIV testing clinic; it would probably save a lot of lives. Another good peice of advice is never use from a new batch alone and if possible never use alone. Also every medic I know wouldn't report you for telling them that the patient was ODing on whatever drug. For the most part a medic doesn't have time to report you to the police, time is critical in saving the patient's life.

trannyboy

[SmokeNmirrors]

Great post pinksox and great thread junkhead very helpful and advice all heroin users need to know.

[kaloochi]

AFs been with people who've od'd aswell as oding himself. He can honestly say he never left anyone. On one occasion someone od'd in AFs flat, a full on blue OD. There was AF, the od-er, a guy with no heart and a girl with no brain. AF sent the brainless one to wait for the ambulance he'd called. AF propped od-er up in a chair [knows now it should have been the recovery position] and waited with no heart in his flat for no brain to come back with the ambulance. After what seemed like ages AF told no heart to wait with od while he went to see where no brain was. It turned out she was at the wrong place even though she'd told the ambulance where to go and had seen the ambulance stop where she'd really told it to but never said anything because she didn't think it was ours.
We eventually got the ambulance and took them round to AFs flat only to discover no heart had gone, leaving AFs front door wide open and od sprawled on the floor where he'd fallen off the chair. Good thing was that as soon as the medics came into AFs flat od came round and was ok. All of those in AFs flat at the time knew each other well, going back before they were on H, but that prick with no heart just left od to die because he was scared of what would happen to him if he did.. What an arsehole.

[H Bomber]

Swim has brought back people from overdoses around a dozen times with CPR alone. Since the fatal part of the OD is the respiratory depression, he figures this is ok as long as the person ceases to have blue-purple lips pretty quickly. Having experienced a IV naloxone injection before, he will try and make sure that the OD'd person can be brought back without having to endure the agony that is going from so high you are practically dead to so sick that you wish they had just let you die, in about 30-60 seconds. He has a vial of naloxone in his kit, but hopefully he will never have to use it on anyone. Swim is no paramedic, he got this narcan by sitting through a 10 minute lecture on its proper use at the lower east side harm reduction center's needle exchange.

[nojokeshere]

So, if I'm sitting next to a person, and they are like unable to keep their eyes open and I have to keep shaking their shoulder and helping them walk around because they fall asleep and stop breathing if I don't... does that mean they OD'd? Like if I didn't keep shaking them and saying, "HEY! You stopped breathing again!"... that person would have died?

And - I didn't see anyone mention anything about throwing up. Where does vomiting come in with the heroin use? I thought alot of heroin users died because they choked on their own vomit, not just stopped breathing.

Please straiten me out.

[msmogadon]

Originally Posted by nojokeshere

So, if I'm sitting next to a person, and they are like unable to keep their eyes open and I have to keep shaking their shoulder and helping them walk around because they fall asleep and stop breathing if I don't... does that mean they OD'd? Like if I didn't keep shaking them and saying, "HEY! You stopped breathing again!"... that person would have died?

And - I didn't see anyone mention anything about throwing up. Where does vomiting come in with the heroin use? I thought alot of heroin users died because they choked on their own vomit, not just stopped breathing.

Please straiten me out.

Yes SWIM is curious about this too. The last 2 night's SWIM's opiate naive partner has gone into a state that once he has shot his lips go purple and his eyes won't stay open. SWIM shouts loud his name in his face and sits him up and just keeps him talking.His eyes continue to close and SWIM has to keep shouting etc. This goes on for about an hour before he "comes to". SWIM believes though however if she were to leave him to sleep he would go into the overdose state that she has seen him in before where his breathing is like gurgling and his lips are BLUE. He also does not respond to pain during 'real' OD, SWIM could pour a boiling kettle over him and he would just lie there!!
Christ that man scares the shit out of SWIM sometimes

[Venusia]

Wow, Junkhead, thank you for this very informative thread. I did not know any of this. I have to ask: this info would be just as pertinent to one who is ODing on pain pills too, I assume. Right?

Again, thanks for posting this. I would have no idea what to do if someone I knew was ODing. This was very helpful. Good thread!

[Spucky]

Originally Posted by venusia

. I have to ask: this info would be just as pertinent to one who is ODing on pain pills too, I assume. Right?

Swiny have to remember that many "Pain-Pills" works much longer
than "Streetdope" like Heroin!
Also the affinity is much higher.

The best is when People call the Emergency!

[Junkhead23]

Yeah it does mention that look:

Put them into the recovery position and check their airways to make sure they have not swallowed their tongue or have been sick and this is blocking their airway.

This is extremely imprtant and yes it does kill people. This also applys to seriously drunk people too!

SWIYmogadon if that is happening SWIY need to have a word because he will kill himself. DNS depression is not fun can't imagine why he would want that.

[msmogadon]

Originally Posted by Junkhead23

SWIYmogadon if that is happening SWIY need to have a word because he will kill himself. DNS depression is not fun can't imagine why he would want that.

SWIM spoke to him this morning and he can't even remember anything about last night.

The plan is to stop using heroin today as he has only been using 2/3 days and SWIM is on 80mls of methadone so it can be done.

The first night was the scariest as he was actually having seizures. SWIM was not even aware that this could happen in opiate overdose.

Please send us some good karma cause SWIwe bloody well need it. Also SWIM has lost her job that she was supposed to start today and needless to say is not feeling like a sugar plum fairy

[Venusia]

A question @ Junkhead:
What is the recovery position? How does one put someone in it ? This part was confusing to Swivy.

[Junkhead23]

Originally Posted by msmogadon

Please send us some good karma cause SWIwe bloody well need it. Also SWIM has lost her job that she was supposed to start today and needless to say is not feeling like a sugar plum fairy

Pacman has a problem. He was reading above sentence and read needles instead!!

fixation

[nojokeshere]

The recovery position. This isn't something from the US is it? Never seen it or heard of it before. I DO like it. Very much better than laying them on their back skit.

It is now set as the background on my desk top... till I memorise it and copy it off to pass around.

[east_of_eden]

after reading this thread, swim asked around and was amazed to hear that swims local needle exchange does give out narcan. swim had no idea. from what she was told you have to speak to the doctor or nurse there first, but this had to be fairly new. swim knows they weren't doing this back when she was going there every week (granted that was probably five years ago at least).

but, swim thinks that is fantastic that there are so many more things available at needle exchanges in the U.S. now (like an on site nurse that can give antibiotics, that's fairly new too).

swim is also wondering what is the "recovery position". this term keeps coming up and she doesn't know what it is.

[Junkhead23]

The recovery position is as follows:



The way you do it is if they are lying on their back you put their left leg up vertically so it is full bent at the knee. Put their right arm to the side like in the picture. Now grab their left hand with your right hand and put your left hand on their knee. Now gently pull them over into said position with right hand and place their left hand under their face.

Hope this helps

[Venusia]

Originally Posted by Junkhead23

The recovery position is as follows:



The way you do it is if they are lying on their back you put their left leg up vericallyso it is full bent at the knee. Put their right are to the side like in the picture. Now grab their left hand with your right hand and put your left hand on their knee. Now gently pull them over into said position with right hand and place their left hand under their face.

Hope this helps

Thank you so much. That is a great way to show how to do this position. Swiv wouldn't have known to do this during an overdose. Very valuable info!
Thanks again.